More Than Proof

 

Here are two facts.  I love Malcolm Gladwell and I am a cynic (realist). 

In one of Gladwell’s most recent podcasts, entitled “Burden of Proof”, he explores the concept of proof influencing dramatic action.  Specifically, Gladwell argues ample proof exists in regards to football players with Chronic Traumatic Encephalopathy (CTE) and the risks of depression and suicide.  As always, Gladwell insightfully articulates a point about the amount of proof necessary before dramatic social action is taken.   

How many football players must die by suicide before dramatic action is taken?

I think of this argument often when addressing the ongoing epidemic of clinician suicide, as a result of the environmental work hazards of these professions. 

How many more clinicians must die by suicide before dramatic action is taken?

The problem with the argument of proof is that it is a myopic argument in a vacuum.  Proof refers to providing evidence in the process of establishing a fact.  Proof exists in the realm of the expansion of knowledge.  Proof is solely about facts.   Proof never independently influences appropriate dramatic social action. 

Dramatic action is a social concept requiring a collective change in behavior.  Dramatic action is much more complicated with cultural influences, personal dynamics including emotions, social pressures, and risk/benefit analyses by all of the involved parties in the construct being defined. 

Dramatic action requires a balancing of the influences above or a predominant driving force capable of overcoming an imbalance.  The risk/benefit analyses are actually separate from the burden of proof, and almost always weighted on a scale of gold. 

The problem with applying the concept of proof to CTE and/or clinician suicide should be obvious because we have already established enough proof.  The problem is in accepting the argument that proof should lead to dramatic action, because ironically, this relies upon two facts 1) an assumption that people value and/or care about the truth 2) the risk/benefit of accepting this truth weigh in favor of the parties involved in making the decisions for dramatic action. 

The risk/benefit for the individual and the institution are often inversely related. 

An individual football player takes almost all of the personal health risks while balancing the financial, social, educational benefits of playing a team sport.  Individuals do benefit, in many facets, from playing this sport.  Yet, it would be easy to argue that lifelong disability and premature death would be risks that some individuals view as significantly greater than the benefits.  Some individuals like Chris Borland, who retired from the NFL at the age of 24, publicly declared the risks of CTE and lifelong disability were greater than the benefits of playing the game he loved. I say some intentionally, because the risk/benefit is different for every single individual and some individuals may feel they have less of a choice.  Some individuals view the risk of physical injury pales in comparison to the benefits of financial peace of mind.  In this case, individual dramatic action was taken by Borland, but the game itself goes on.  Next man up. 

I speak to caregivers all over the country about this very topic and the same issues ring true.  For many, there is an ongoing internal turmoil in weighing the risks/benefits of continuing on in a career that carries a significant risk of addiction, mental health crises, and suicide.  Yet, it can be a lucrative and distinguished career, while also acknowledging that a lot of individuals feel trapped by 300-500k of student loan repayments. I have several colleagues that have critically weighed this risk/benefit and found a way out of medicine.  Reflecting that the risks far outweigh the financial, social and educational benefits.  Although still working in medicine today, I continue to critically analyze this ratio as well.  I will walk away tomorrow if the risks outweigh the benefits again. 

In football or in medicine, Individuals in this cauldron have the ability to analyze truth in making these decisions while weighing the risk/benefit for themselves.  Proof therefore can influence dramatic action on the individual level, in individuals changing their own behavior, but this is still far from the norm. 

On the institution level, NFL or healthcare systems, the risk benefit analysis looks completely different.  Institutions do not possess individual autonomy and are submissive to a capitalistic model of business bottom lines.  I do not say this maliciously, I say it because it is an American ideal and simply true.  The risk of losing a handful of individual football players to suicide is a blip on the radar of a multi-billion dollar business.  Even a 765 million dollar lawsuit to compensate players/families diagnosed with CTE is a drop in the bucket of a cash machine business.  Social pressure may exist but not in a volume that can overcome the revenue stream.  The same concepts are true in healthcare, a business that has now reached 17.9% of the Gross Domestic Product (GDP) of the United States.  The cost of losing one physician to suicide is conservatively 500k (lost revenue, recruitment and replacement).  This financial loss is also a drop in the bucket when referring to a multi-trillion dollar healthcare industry.  400 suicides a year equals a 200 million dollar loss.  The game goes on.  Next man up. 

Neither of these ongoing national epidemics are now about ample proof of the pathology in relation to the evolving epidemic.  Now, both epidemics are solely about proving we care more about individual, suffering human beings than we care about money. 

 

Ability

 

One by one, pictures scrolled across a dangling white screen in the back of the communal eating hall. Photos of children at play, running in fields, climbing towers and building canoes.   A ritual of storytelling about the events of the unfolding week.  Each photo greeted by modest cheers, chuckles or rib poking gestures from those in attendance.  

And then, a thunderous applause erupted that brought tears to my eyes.  

This was the setting of our final night at summer camp this year.  The final night of every summer camp, in which a slideshow highlights the accomplishments of a week where children living with cancer come to the woods to find solidarity, have fun and be kids.  I have the privilege of being their “camp doc” for the week while experiencing first-hand the instantaneous comradery of children living with shared life experiences.  

The camp welcomes all, from children actively going through radiation and chemotherapy treatments to individuals years into remission from their cancer.  And they can bring a friend or sibling too.  Amongst those in attendance are several individuals with their own physical limitations secondary to the devastating side effects these treatments can inflict.  Limitations in mobility, speech or processing.  Wheelchairs, canes, hearing aids, or ankle braces.  Often viewed as lifelong disabilities that “limit” individuals from their ability to accomplish or achieve.  

The applause continues.  

In our current cultural climate it has never been more imperative to challenge this pervasive social narrative, as we witness funding, access and social norms being slashed in terms of addressing all of our own physical differences.  Public mocking and separatism have become an insulting and divisive new norm.  A broadening failure to highlight our own abilities.  Instead we critically dissect and magnify other people’s failures and/or limitations.  

The applause begins to subside in a natural crescendo after several consecutive photos of the same camper roll off of the screen.  The still portraits projected a young child with her own unique set of abilities, accompanied by a walker and a steadying hand.   In these moments, she was being ceremoniously applauded, frame by frame.  A picture of her on horseback, at the rope swing and painting a canvas.  The beauty of the applause was that it was never seeking attention for its presence.  It was merely an unscripted instinct.  Pure joy, spontaneous love and respectful recognition only cheering for the human being, not because of any physical limitations but despite it.   Recognizing her accomplishments and achievements not as distinct or different, but to be celebrated all the same.  

Then the next set of photos came rolled along of other campers, and the cheers continued.   As if the moment was supposed to happen that way. No camper thought twice about it. No one looked around for an endorsement or tacit approval.   No breaks, pauses or social clarifications. 

In my own misty eyed reflection, I was overcome by the moment.  A moment that revealed a culture in the woods.  A culture that highlights, celebrates, applauds and cheers human accomplishments.  Not with a measuring stick, or a weighted scale.  Not merit based by physical strength or intellectual quotients.  Measured in terms of solidarity to a family of individuals living with shared life experiences, accepting of our own, and celebrating the unique abilities we all bring to the table.  

I hope that we can all clap for that.  Thunderously. 

 

(D)evolve

 

The fear I have about healing is that we will never learn to evolve, in terms of the way we treat each other.  

The solution may be that we must simply devolve to a basic set of core societal principles that promotes the healing powers of community, individual presence, and the empathic connection of one human being to another.  

In the current epidemics of suicide, from farm workers to millennials, medical providers to the elderly, I fear that we will rest of the principles we have constructed to define this problem while only searching for artificial checkbox solutions.   

The narrowmindedness of the box is part of the larger problem.  There is a cultural assault ongoing, requiring dramatic cultural shift solutions.  A simple checkbox solution only pacifies the guilt of the individual(s) writing the list.  A deep breath exhalation allowing for a single head to hit a pillow softer at night, in the gratification of a checkbox task completed.   This approach does not solve any problems, it may only create more.  

Here is the real life example.  

I know two colleagues, each one struggling with their own journey of mental health over the past few months.  

The first colleague smiles every day at work, puts on a brave face and grinds through the day.  A work colleague developed a sense of worry and concern over the last few weeks after a string of difficult encounters.  The colleague urged the individual to seek out some medical attention for their ongoing medical condition, in a tone of offering medical advice.  A directive from a lofty, soapbox position.  The colleague refused.

“I’m fine”.   

The urgency escalated and the colleague continued to push for the individual to seek out assistance.  Another colleague requested a mandatory mental health screening be done.  The colleague shut down, retreated and no longer confided in close work colleagues.  The concern escalated to a workplace leader and the individual was given a week off of work to seek out some form of medical assistance.  The checkbox solution of attempting to check in, require screening, mandate time off work while forcing an individual into a treatment pathway pacified the system, yet failed the struggling individual.  The individual felt targeted, singled out, disciplined into seeking treatment for a medical condition.   Albeit, necessary at times, this process does not have to be doomed before it even starts.  

The second colleague suffered a handful of tragic personal losses over a short amount of time. Drowning in a sea of personal pain, guilt and grief.  Her colleagues surrounded her with compassion and a listening ear.  They created a personal, intimate and non-intimidating space.  They shared in their own personal stories, their own struggles, and offered up a solution that was outside of the checkbox list.  They created a cultural moment that willingly embraced their own insecurities, and their own flaws.  More harm can be done by demanding to someone that "it is okay to not be okay".  It must come from authentic people willing to live and share in the truth that is really is okay not to be okay.  They didn’t mandate, discipline or dictate that her suffering was abnormal or maladaptive.  These colleagues built a culture that allowed them to recommend a counselor, coupled with the statement “because I have been to counseling too”.   The individual openly sought treatment, confided in workplace associates and continued an open dialogue along the way.  

The first colleague still struggles after feeling relegated into a box, pigeonholed into a disciplinary pathway of sympathetic, shame based distancing from any understanding of the complexities of the individual struggles.    

The second colleague went to counseling with an open-mind, in the acceptance that friends and colleagues have been there too.   Acknowledging that they may not have personal experience with any specific type of loss, but that they were willing to share their own truth, in order to ease the moment and balance the scales of vulnerability into a space willing to produce more of it.  

We can’t promote ourselves out of a mental health crisis or a suicide epidemic.  We can’t think in terms of simple minded, checkbox logistical solutions. We must attract individuals to safekeeping by the messages of individuals willing to share in their own experiences.  Less vinegar when more honey is needed.   The intertwined honeycomb of building something greater together – person to person.  

Culture change will never be about checklists, boxes, mandates or pathways.  Culture change is about human connection, spreading widely into the smallest of silos that will reach individuals in their greatest times of need.  

It is never too late to devolve back to the roots of human to human storytelling.  Listening with compassion, and evolving the ways we think about healing each other.   Every single, individual success story relies upon it.  

 

 

The Same Old Record

 

“This guy must have it all figured out”

Reading this blog, some people may actually believe that.  If you want to protect yourself from any spoilers, then please stop reading now.  

I don’t.  (Spoiler complete) 

I just spent the last 36 hours ruminating over a disappointment.  A trivial blip on the radar of anything humanity would justify as relevant or important.   Yet, it meant something to me and it took me until this evening to finally let it go. 

In the midst of my darkest depression and my addiction I spent weeks and sometimes even months dissecting, self-criticizing and punishing myself for the words or actions of other people.   

Every single line of an email was a direct criticism to the core of my being.  Every off-handed comment or gesture critiqued my very existence.  Every staled glance in the hallway was a glare of disappointment. It simply became easier to keep my head down.  The floor never glared judgingly deeper into my soul.   Night after night, I let other people live in my head.   Night after night the words of other people kept me up until the middle of the morning.  Restless. Defeated.  Critical.  

If I slept, I woke up to the same echoes in the mirror.  The same projections of their broken records scratching into the soundtrack of my daily life.   A spiraling, circular pattern on repeat, worn like a Neil Young album on my father’s old 45.  Less melodic at times, yet somewhat heartbreaking all the same.  

“You aren’t good enough”

“Why couldn’t you have done better?”

Unless you have lived it, no one truly knows the expenditure of exhaustion these recorded tolls can take.  A skipped record scratching into an infinite descension.  Grasping for an arm to simply make the stylus needle stop.  

Today, I found myself in this same repeated cycle as the self-doubt began to creep back into my life. A trivial disappointment amplified through a megaphone of the trials of my past.  A moment where I retreated to the essence of my own learned behavior defaults – to run, to hide, to blame myself and keep my head down to the floor. 

“You aren’t good enough” 

“You should have done better”  

In the early morning, years of counseling helped me to lift my gaze from off of the floor.  To make contact with the world again and to keep my eyes open.   In the late morning, self-reflection reminded me to take the record player down from the shelf, to stare at the turning disc with a fresh set of eyes.  To reflect deeper into the words of the song.  By early afternoon, mindfulness allowed me to listen to the song with all of its glorious imperfections.  Not just the screeching repeats, but the holistic tune sung by a larger symphonic orchestra.  By the end of the day, an army of friends came to listen to the song too.  They listened and they heard a different melody all together. They reframed a meaning of which I was missing the entire time.   

And after the track was finished, played until its whining conclusion, the last friend picked up the record and smashed it.  Crushed the tired, repetitive hatred into a million distinct pieces of an insignificance deserved.  We laughed and hugged in a newfound silence.  

“Don’t worry. Together, we can figure this all out”.   

 

 

PATIENT 

 

The competitive furiousness of education, training and working in healthcare sits in the most ironic and complex juxtaposition to the patient mindfulness needed to thrive within it.   This tone competes daily in an offensive, stressful and contradictory way to any capacity needed to actually heal. 

Our own patients.  Our own patience.  

Systems constructed to deliver services in efficient terms, to compile numbers of encounters for consumers, mindful only of the clock and the bottom line.   Human beings working within these systems distilled into products to be launched in a framework of deliverable healthcare services.  Analysis of workflows generate schematics to deconstruct an algorithm of effectiveness.   Universally interpreting the data with the wrong outcome measures in mind.  

In the most systematic and efficient way, we have devalued the greatest resources we have in the art of healing.  The healing power of the individual person.  Instead of formulaically minimizing this power, we must foster and encourage this innate capacity, inside and outside of the walls of medicine. The power of simply being emotionally available, showing up, and being patient in moments requiring human compassion.   

In recovery, I learned to harness the powers of compassion and mindfulness.  Taking time to dedicate in self-reflection about my patients and my own patience.  Above all, this process (as well as having two young children) continues to teach me the value of holding my own space for personal emotional exploration.  While, creating a space for honest human connection and holding the door open to the vast uncertainty of emotions strolling through the passageway.  This emotional operation reveals the necessary value of providing safe spaces to process, in a way that promotes a holistic healing deeper than what we superficially implore.  

For our patients.  For our own patience.  

A family admitted to the hospital for the 26th time in the last 4 months after their child endured 10 different brain surgeries.   The value added in listening to their story for almost 2 hours on a late Tuesday afternoon, while holding a space for their worries, fears, concerns and questions.  An amount of time defined only by the duration of the necessity of the wounds they filled with their voices.  

A young father, losing his daughter to an illness beyond comprehension, in a foreign country, a foreign language, foreign customs and unknown medical ideals.  Sitting in prayer, reflection, and in silence at the bedside without once checking the clock.  Not in an attempt to explain the unexplainable.  Simply to be in the presence of it, and feel with him in the moments where no words will ever find their justice.  

A young man, in his early 20’s, dying from a rare and recurrent sarcoma, wishing to be back in the hospital to spend time with his friends (his medical care team) at the end of his life.  Listening to his stories in the absence of any pressure or any rush.  Holding a door open for his wishes and being emotionally available to share in moments of reflection about his hopes and dreams. 

A single mother, forced into the contemplation of losing her only child after a complex heart surgery. The anticipatory grief too palpable too bear as she cycled between shock, denial and despair.   The ability to be present, show up to hold vigil in patient preparation for a moment of deliverable need.   

Years into my own recovery, I have learned the immeasurable value that resides here in these spaces. The outcome measure that is hardly ever defined or measured in any complex algorithm.  The power of human connection measured in patience and presence.  The power of empathically acknowledging that another human being is suffering in a way impossible to fully comprehend.  And still I will sit here, be available and offer support in whatever ways I can. 

Moments of varying scale happen all around us, in every day and within every encounter.  Hold a door open to permit their safe passage.  Show up with your presence in a way that promotes the greatest healing humanly possible.  The human healing power of presence. 

And of being patient. 

 

About Time

For 482 days, I felt alone. Abandoned. Forgotten. 11,568 hourly circumferences of a clock, ticked and then tocked into a melodic cackling that echoed into an empty room.  694,080 minutes, as I withered away into the spirals of a demanding depression.  Every number, every multiplication leading here coated in a sadness, in a sorrow and in pain. In the darkness, sleep ebbed and flowed from the pulse of sporadic and intrusive thoughts.  Tick and then tock.  Minutes mattered less, and hours mattered more in the midst of insomnia.  The bottle yielded a temporary reprieve.  The days were numbered.  

I would have told you that I wanted it this way.  No one could ever want it this way.  A thrusting oxymoron of living life on the edge of wanting to leave it.   As I wallowed, I grieved and I promised.  I pondered and I relinquished.  Hope relieved of any expectations.   And as I sank, I floated further away. Intentionally and never on purpose. For 41,644,800 seconds I felt this way. 60 seconds later and it may have been too late.  

As the seasons of life turned, the clock restarted with a sobering click and a new day.  For 1773 days, I lived sober and self-sufficient. A treatable depression and a daily fight for my own sobriety.  42,552 hours of dedication to reclaim a life from the brink.  2,553,120 minutes of showing up to meetings, distracting myself from triggers and making my own amends.  For all this time, I felt temporarily proud of the tidy box I had created.  Living neatly in a nest, felt like an ever enclosing cage.  I was content, stable, balanced and empty.  Safe, sober, protected and unsatisfied.  For 153,187,200 seconds, I lived this way.  Minute to minute free of the darkness, and hour by hour longing for something more.  

It has been 629 days since I first told my story of depression and alcohol abuse in public.  15,096 hours since discussing the darkness of those 482 days.  For 905,760 minutes I have finally felt free.   Unencumbered from any cage and liberated to a truth where hope transcends any expectations.  Relinquished of any disingenuous secrecy, intentionally and on purpose.  Exercising the muscles of recovery to prove that strength comes from repeatedly lifting a load too difficult to handle.  Time after time.  Multiplying a voice to echo into the crevices of the emptiest and darkest of rooms.  Adding to a calling and calling to a number of those still floating further away.  

Minutes matter more. As do hours.  And every ticking second of the clock is the dawn of a new day.  

For 54,345,600 seconds I have felt this way.  

54,345,601, 54,345,602, 54,345,603..…. 

The Truth in Our Tears

Today was an ordinary day of rounding, meetings, patient visits, notes, emails and dictations.  Chaotically rushed from moment to moment by the nagging memory of the work left undone.  The beckoning of pagers, labs left unsent, and x-rays still to be read. The ticking clock of resident duty hours, medical students awaiting afternoon education, and the impending night of sign-out and overnight call.  

Yet, at high noon, on a Tuesday, in an nondescript classroom, fifty people gathered together.  Fifty people from all walks of life, collected together in mass for a scheduled resident lecture.  

Then something remarkable happened that revealed the truth in our tears.  

I wish the world could see what I have the privilege of seeing.  Physicians crying.  

Through the logistical minefield of the nuisances of modern medicine, people found their way together. A necessary together.  To share a moment and hold a space.  Not a defined moment of time, but yielding dignity to the preservation of space.  And then, together we did something that we do not do enough in medicine.  We talked about the tragedy of seeing our patients die.  We dedicated time to listen.  And we mourned together.  

One brave colleague shared about the struggles of seeing a patient die on the hospital floor and how to process a nurse asking, “Is this dose of morphine going to kill her?”  

Another young resident shares, “I went to a funeral of a child last week while there were other children running around in the church lobby…”.  

Two seats away, a tearful physician, “I was on vacation, just to come back to find out a patient I cared for had passed away….and I didn’t even know”.  

Three colleagues walk over to embrace each other in a moment of instinctual grace.  

The faculty listened. We cried too.  We attempted to share our own stories of tragedy, loss, grief and processing.  We attempted to provide comfort to an organic space where vulnerability could exist to a degree worthy of these tears.  We attempted to create a moment capable of transporting us all back to a time when the innocence dripped off of our brow like water droplets from a summer sprinkler.  An innocence unafraid to expose truth.  Unveiled from expectations.  A truth revealing an acknowledgement of the flowing principles of our basic humanity.    

It is into these moments, I carry Luke, Bailey, Audrey, Riley, Conner, and Carter.  Into these moments, I remember Lacy, Khalid, Austin, Emily, and Nathan.  Into these moments, I cherish Sam, Paco, Joshua, and Alex.  In these moments, I hold Zoe even closer to my heart.    

To witness this heartbreak, in a room of physicians, should tell the world something.  These are the moment I wish the world could see.  We carry the love of our patients with us.   It deeply affects us all.  We carry it close to our hearts, and on the tips of our tongues.  We do not forget.  We will always remember the impact the lives of our patients have on us. And when we do it right, we mourn together too.  We acknowledge our humanity in a moment yawping for our basic needs to be human too. 

We must do it right.  The humanity of our medical community relies upon it.  

 

SICK

 

A few days ago, I received a phone call from a colleague.  A pensive call, fraught with hesitation.  

On the other end of the line, a dear colleague calling with what could have been a simple invitation. 

“Sorry, this is last minute. But, we are hosting a poker tournament on Saturday.  We wanted you to come, yet we hesitated to invite you because there will be a lot of gambling and drinking.  We do love you, so we wanted you to come”.  

Living openly in the world with a history of depression and alcohol abuse is complicated.  

I have learned through 6 years of recovery, and 2 years of living openly in the medical community that I am treated differently than other people.  In the beginning, I struggled to view this as a gift.  

Let me further explain. 

In four years of my current job, I have taken one full day off for being “sick”.  During that time, I felt a huge cloud over me.  A guilt, a pressure, an unrelenting aura of speculation. The permission to be physically sick at all, in the world of medicine, is a whole different blog for a different day. Yet, when I was physically ill from a seasonal iteration of gastroenteritis, my past haunted and beaconed for a deeper and more profound explanation.  A gastroenteritis absence demanded a public comment.  No, I am not depressed.  No, I am not drinking.  

I wear an invisible leash constraining any ability to have an “off day”.  If I’m tired, stressed, overwhelmed by the mundane, monotonous and everyday occurrences of work and life (and life with two young children) there appears a societal asterisk next to these events.  People ask me “How are you doing?” with a different tone, and subversive sub context.   Almost bleeding out the tip of the tongue connotations “I wonder if he is going to kill himself” today.   

People invite me to dinner parties and social gatherings differently.  Reluctantly.  As if the mere presence of alcohol will force me to toss tables and spiral into a moment of stealing liquor from an open bar.  

If I come into work 20 minutes later than my routine schedule, people rush into my office insistent on a sit down “check in” requiring an over explanation and emotional intrusion into the morning tasks.  “No, seriously.  How are you doing?”  

The truth.  My kid hysterically melted down getting in the car.  It is a typical Wednesday morning.  

If I need to take off early, or arrive late for a doctor’s appointment, scheduled meeting or “out of the routine” event, I feel the need to meticulously explain the necessity and my whereabouts at all times.  Feeling like the absence of such iron clad, social documentation will open the void to unearth unspoken and lingering questions, “I wonder if he is drinking?”.  Ironically, even when the absence is merely to drive across downtown to undertake mandatory drug screening for my professional recovery program.  

I am an emotional human being.  It is who I am to my core.  It allows me to be proficient in the work I do with patients and families.  I have normal human reactions and emotions to these events, and yes, it is difficult work.  Yet, I have the same human reactions we all do during a busy day/week at work.  I get stressed.  I get overwhelmed.  I get tired and defeated at times.  The difference is that the once invisible dotted line is easier to connect.  I made that easier for people.  Stress is bad.  Overwhelmed is a red flag and tired is a warning sign.  Adam has a history of depression and alcohol abuse.  Routinely, I have colleagues call me during these times and say “Let me buy you a cup of coffee and let’s talk”.  In the beginning, I naively and defensively assumed that I had to use these moments to convince other people that I am okay. That, once again, my own ability to have emotional reactions were constantly being questioned and needed further explanation.  “I’m fine. Don’t worry about me”.  

Here is the gift. Over the last few years, I have witnessed this process as the beginning of a cultural revolution in the medical community I work in.  People actually care.  Colleagues actually care deeply about me and about each other.  The intentions are pure.  The execution may be flawed and the delivery awkward at times, but behind that is a genuine care for my wellbeing.  And how incredible is that?  I can come to work in an environment where I am fully supported, loved and routinely checked in on by dozens (if not hundreds) of colleagues.  

Living openly has gifted this connection.  Living openly has given social permission to be invited into spaces where the sub context becomes open dialogue.  Colleagues hesitate about social functions out of naivety perhaps, but with a genuine interest in my wellbeing.  Work friends come into my office when I arrive at work off-schedule because they genuinely care about my morning, even if there is a deeper hidden concern.  It shouldn’t matter why they are sincerely, authentically asking “How are you doing?”.   The mere fact that the question is being asked in a different way is the entire point.  And not just in a different way, but also waiting for different, deeper response. 

The beginning of a cultural revolution in the way we heal each other, the way we embrace wellbeing starts with this.  A simple question.  “How are you doing?”.  By genuinely meaning it, creating a space that will allow for an honest response and then patiently, compassionately waiting for the answer.   

Please worry about me. It is okay.  Thank you for caring enough to ask. 

  

The Delay

Sorry for the delay in the blogging cycle.  Life happened and work happened. 

Putting writing on hold for a month, while navigating the nuisances of life, was a great reminder of one of the greatest struggles of my own professional life and career.  A struggle, I fear, overwhelms a lot of young professionals and contributes to a larger void of self-care and feeds vicious cycles of personal distress.

When I was a second-year medical student, I adopted the mindset of grinding through the rest of the academic year until I would be able to do clinical rotations in my third year of training.  As an intern, I promised myself that upper level residency would be more fulfilling.  As I transitioned into fellowship, I knew that I would finally be doing exactly what I loved to do.  As a first-year fellow in oncology, I survived day to day with a personal peace that once I was an upper level fellow I would finally have a voice, an autonomy and a deeper meaning to the work I was doing. 

Year after year I delayed the gratification with an earnest acceptance that the rainbow of personal satisfaction was just over the next hill.  Finally, during fellowship the broken promises caught up to me.  The relentless void of nothing changing broke me to my core.  The grind became hopeless and the work leading to that point meaningless.  I learned helplessness in a rat cage of cycles of consistency in the same repetitive grind.  The lever and the delay. 

For years, I put life, love, happiness, and self-discovery on the back burner until all of those pots were boiling over.  I delayed any personal gratification in order to pursue professional achievements and success.  I put out fires, I triaged and I survived (barely).  Then, nothing changed and there was no greater reward. 

This lesson reminds me to seek my own fulfillment first.  To take care of myself and my needs first, in order to help other people.  I learned that I can no longer grind, no longer delay any gratification in the hopes that everything else will change in the future and fit into place.  I am the controller of my own destiny.  Only I can control the environment in which I live and work by my own mindful interpretations of it.  The rest is out of my control.  The lever doesn’t matter, nor does the cage.  How I choose to think, and how I choose to act are in my control.  I write today because I no longer grind in the day to day seeking a broken promise.  I live today on its own merits and with the gratitude that resides in it.   Do not delay gratification.  Seek it, find it, own it and live in it now to create your own promises for the future.   Start now.  Do not delay. 

 

For Grace

 

I do not know why I am still alive.  I did not know.  I do now. 

Grace. 

For those unaware of my story, I survived into the depths of depression and calculated a plan to relieve the ongoing suffering in my own life.  A tangible and thoughtful plan.  A plan conceived from the caverns of defeat and apathy of a career and life devoid of meaning.  For grace, I called my wife instead. 

Grace has many conceptions, many interpretations and therefore extends a variable meaning to all of us.  For me, grace is revealed in the blissful ignorance and unmerited assistance provided in the moments I will never understand.  The moments I do not need to understand.   For there is grace, and I once again have found a meaning and a purpose. 

Grace called me to reclaim a life of purpose with my wife, a deeper connection and a deeper mission.  In this process I was introduced to gratitude, patience, and persistence.  Grace permitted me the opportunity to restart, recoup and recollect the neglected portions of my own soul, of my own marriage and our future.  I owe her that.  Grace that is. 

Grace guided me into a new career of profound meaning, an opportunity to help others in their own rudderless moments of loss, heartache and suffering.  Privileged me with the blessing of presence, compassion, and empathy.   Grace exposed the vulnerability of my own limitations, my own scars and my own existence down to the bone.  Raw enough to be genuine, honest and human.  A sincerity in the work, the calling and a mission larger than my own.  For grace. 

Grace loaned me today, and taught me to be thankful for it.  Grace reminds me that I am flawed, and perfect in my own failings.  Grace forgave me, and permits my own path forward.  Grace honors the efforts and elevates the volume of a single voice.  Grace defined meaning and purpose again in this life and paved a way through the pathless nothing.  Grace found a life worth living, in every setback, in every triumph and every blessing along the way.  For, there is grace. 

Grayson Robert and Zoe Grace …..

Our children.  

                                                                           - Adam B. Hill, M.D.